Provider Demographics
NPI:1023402690
Name:MORREALE, SAMANTHA NOELLE (NP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NOELLE
Last Name:MORREALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1251
Mailing Address - Country:US
Mailing Address - Phone:716-298-4869
Mailing Address - Fax:888-847-3060
Practice Address - Street 1:2931 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1251
Practice Address - Country:US
Practice Address - Phone:716-298-4869
Practice Address - Fax:888-847-3060
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307256363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY307256OtherNEW YORK STATE LICENSE